ADA guidance puts semaglutide and tirzepatide first for weight care in diabetes

The American Diabetes Association placed semaglutide and tirzepatide at the front of its weight-management advice for people who have diabetes along with overweight or obesity. The recommendation sits in Section 8 of the ADA's Standards of Care in Diabetes—2026, released December 8, 2025 ^[1][2].

Section 8 covers obesity and weight management for the prevention and treatment of diabetes, running from page S166 to S182 in the January 2026 supplement of the journal Diabetes Care, volume 49, supplement 1 ^[1]. Recommendation 8.18 carries the ADA's highest evidence grade, A, and states that the preferred pharmacotherapy for this group should be a GLP-1 or dual GIP/GLP-1 receptor agonist with greater weight loss efficacy, naming semaglutide or tirzepatide ^[1]. Semaglutide is the molecule in Ozempic, Wegovy and Rybelsus; tirzepatide is in Mounjaro and Zepbound.

Two companion recommendations address how long treatment runs and how much drug is used. Recommendation 8.19 says treatment should continue beyond reaching weight goals. Recommendation 8.20 says the optimal dose may not be the maximum approved dose ^[1]. The ADA's own rundown of the 2026 edition flags "new guidance on obesity pharmacotherapy dose individualization in people with diabetes" among the year's notable updates ^[2].

The section also treats weight itself as a target. Recommendation 8.4, another grade A item, says weight management should be a primary goal of treatment along with blood sugar management in type 2 diabetes with overweight or obesity ^[1]. Recommendation 8.5 notes that losing 5–7% of baseline weight improves glycemia and other intermediate cardiovascular risk factors, while sustained loss above 10% usually brings greater benefits, including disease-modifying effects and possible remission of type 2 diabetes ^[1]. The ADA describes obesity as a chronic, often relapsing disease ^[1].

The Obesity Society endorsed Section 8 ^[2][3]. The ADA says 136 million Americans live with diabetes or prediabetes, and the Standards are refreshed each year by its Professional Practice Committee, co-chaired this cycle by Mandeep Bajaj, MBBS, FRCP, and Rozalina G. McCoy, MD, MS ^[2].

Why it matters for patients

These are clinical recommendations written for health care professionals, not coverage rules. Nothing in the published material says whether insurers or pharmacy benefit managers will change what they pay for or how they handle prior authorization, so that has not been disclosed ^[1][2]. What has changed is the ranking: for a person with diabetes plus overweight or obesity, the ADA's stated first choice among weight medications is now a GLP-1 or dual GIP/GLP-1 receptor agonist with greater weight loss effect, identified by name as semaglutide or tirzepatide ^[1]. Someone taking a different drug has a concrete benchmark to raise at a visit.

The duration and dose language may come up in routine conversations too. Recommendation 8.19 pushes back on the idea of stopping once a goal weight is reached ^[1]. Recommendation 8.20 draws a line between the largest approved dose and the right dose for one person ^[1]. How a clinician should settle on that dose is not spelled out in the recommendations, and no dosing instructions appear in the published text ^[1].

Scope matters as well. The recommendations are written for people who have diabetes with overweight or obesity ^[1]. Use of these medications by people who have obesity but not diabetes falls outside that focus, and no new advice for that group appears in Section 8 ^[1].

What happens next

An Abridged Standards of Care aimed at primary care professionals is planned for spring 2026 in the journal Diabetes, Obesity, and Cardiometabolic CARE ^[2]. The ADA also keeps a "living" online version that it says is updated in real time through the year as evidence and regulatory decisions change ^[2]. A quick-reference pocket chart is expected to be sold through ShopDiabetes.org, and an app with interactive tables and algorithms is available for iOS and Android ^[2].